NC HIEA September 2023 Update

ACURE4Moms Participants Go Live with Maternal Health Alerts, Understanding TEFCA and Interoperability, Lessons from Civitas Annual Conference

Author: Jessica Hagins

ACURE4Moms Study Update: New Facilities are Live to Receive Alerts through NC*Notify

Six maternal health care facilities that are participating in the ACURE4Moms study are now live in production to receive Maternal Health Alerts powered by NC*Notify.

UNC Panther Creek, UNC Weaver Crossing, UNC Maternal Fetal Medicine at Rex, UNC Horizons, UNC Maternal Fetal Medicine at Vilcom, and Galatians are now connected to the event notification service.

The ACURE4Moms study seeks to improve health outcomes for Black mothers and infants by addressing institutional racism and bias in health care processes, gathering health care data, and providing community-based, social support in the form of doulas. The primary desired outcome for the study is to decrease low birthweights.

This Maternal Early Warning System generates alerts with information available through NC HealthConnex and is set up through NC*Notify, a subscription-based alert service offered to full participants of the N.C. Health Information Exchange Authority. The facilities can receive alerts when a patient has a risk factor for low birthweight, including any physical, mental, or social risk factors related to the study.

A total of 40 North Carolina clinics are participating in the study and are all full participants of the NC HIEA. The Full Participation Agreement gives them access to NC*Notify and allows for a bi-directional flow of health data that will be necessary for the data arms of the study, which are:

  1. The control group will provide standard care management and enter standard obstetrics and other health data into their electronic health record (EHR) software.
  2. The data arm will add practice-based data interventions to their standard care practices. This would include the use of the Maternal Early Warning System notifications.
  3. The doula arm will match high-risk patients with doulas who are trained to provide care and support during prenatal and postnatal appointments.
  4. A combined data and doula arm will use all three methods – standard care management, practice-based data interventions, and community-based doula support.

The participating clinics were randomly assigned to one of the four arms last year. Only those in the data arms, half of the 40 practices, will be receiving the maternal health alerts.


Improving Interoperability of Health Information Exchange through TEFCA

By now, you may have heard terms like TEFCA, QHIN, interoperability, and recognized coordinating entity. They are all very important to understanding a mandate included in the 21st Century Cures Act, signed into law in 2016.

The law directs the U.S. Department of Health and Human Services to create a “trusted exchange framework (TEF) for trust policies and practices and a common agreement (CA) for exchange between health information networks.” TEFCA is that Trusted Exchange Framework and Common Agreement. It is not a network itself, but a set of shared principles, terms, and conditions that are part of an agreement to foster exchange of health information nationwide across multiple health information exchanges, such as NC HealthConnex. These HIEs are sometimes referred to as health information networks, or HINs, but both terms refer to the same type of system.

The Sequoia Project is the Recognized Coordinating Entity (RCE), appointed by the Office of the National Coordinator (ONC), to develop, implement, and maintain this Common Agreement. The agreement includes technical and legal requirements for sharing electronic health information.

HIEs that want to join in this agreement would apply to become Qualified Health Information Networks, or QHINs. At this time, only seven organizations have been approved to be considered as QHINs by the RCE. Please note, this does not mean they have been approved to become QHINs, only that their applications have been approved for consideration. They are:

  • CommonWell Health Alliance
  • eHealth Exchange
  • Epic Systems
  • Health Gorilla
  • Kno2
  • KONZA National Network
  • MedAllies

QHINs are at the core of this framework and are responsible for routing queries, responses and messages between members (subparticipants) of participating HIEs. These subparticipants would be entities such as health systems and health care providers.

This graphic helps explain the participant structure:

Infographic explaining structure of TEFCA as described in the article.


TEFCA and the N.C. Health Information Exchange Authority

All HIEs face a pivotal decision at this time to become a QHIN or to connect to a QHIN as a participant. Participation in TEFCA is optional, and participants can only be a part of one QHIN at any time. For example, a health care system that uses Epic may choose to be a part of the Epic QHIN. Participation does not prevent them from also connecting to their local non-QHIN exchange, such as NC HealthConnex, the state-designated health information exchange for North Carolina, and benefitting from query-based exchange and other services such as ADT alerts and registries.

The N.C. Health Information Exchange Authority (NC HIEA) as the governing body that oversees and manages NC HealthConnex, is currently a participant of eHealth Exchange. While NC HealthConnex connects providers throughout the state, data exchange with neighboring HIEs and providers is possible through eHealth Exchange.

eHealth Exchange has opted to apply for QHIN status. As a participant of eHealth Exchange, the NC HIEA has the right to opt out or change its QHIN affiliation. At this time, we are choosing to opt out of participation with TEFCA. Note that this does not change our current data connections with eHealth Exchange.

The reason we are not participating in TEFCA at this time is that we believe NC HealthConnex is currently serving the needs of North Carolina health care providers very well with our regional health information exchange services. There is currently no need to undertake the significant technical and governance changes that may be required of participants.

We are continuing to stay informed on developments in TEFCA. As it matures and becomes a more fully realized and robust network, the NC HIEA will look into future participation. Organizations have the right to opt in or out at any time. We also welcome feedback and questions from our participants to determine if there is a large demand for TEFCA involvement from North Carolina providers. Please reach out to us at with your thoughts and questions.


Civitas Networks for Health 2023 Annual Conference Talking Points

NC HIEA employees furthered their education and industry knowledge at an essential health IT conference last month.

The Civitas Networks for Health 2023 Annual Conference was held in the Chesapeake Bay region of Maryland. Civitas Networks for Health is a national collaborative of member organizations, such as health information exchanges and regional health improvement collaboratives, that seek to use data to improve health care. Their annual conference brings together private and public sector employees, as well as state and federal policymakers to learn more about interoperability, care coordination, health equity, and more.

Here are some of the key takeaways from NC HIEA staff members who attended:

“The Civitas conference offers valuable time to network and collaborate with HIEs and health care collaboratives across the country, expanding our understanding of new and innovative use cases and providing insight into challenges that we are working to overcome. HIEs are undergoing a transformation, spurred by the COVID-19 pandemic and 21st Century Cures Act, to build statewide data utilities to support Medicaid, public health, and human services agencies. North Carolina is well poised for this model.” – Christie Burris, Executive Director

“HIEs are leveraging social and health data sharing to close community-based organization (CBO) referral loops and improve health equity and outcomes for communities served. Patients opt-in, providing consent for the community-based exchange service, allowing the HIEs to share limited data sets with CBOs to help populate and pre-fill applications for services such as WIC, which improves participation rates.

"HIEs are asking public health agencies on a local, regional, and national level to use the HIE infrastructure in place to share data and dashboards with the communities.” – Karon Casey, NC*Notify Technical Lead

“Not all HIEs are built the same. Some are state-mandated, like NC HealthConnex, and others must form unique relationships with community and state agencies to accomplish their patient and public health goals. At the end of the day, all HIEs have something valuable to learn from each other.” – Fred Eaker, Implementation Program Manager

“As a new employee with the NC HIEA team, I learned a tremendous amount by attending insightful sessions and presentations from state HIEs, tech companies and health leaders from across the country. As a team, we participated in interactive discussions with health and IT leaders and got to know members of the vendors we work with, including J2 and SAS. As a first-time attendee to this conference, I thought Civitas did a wonderful job highlighting the necessary collaboration needed to achieve data sharing to support patient care.

"The two main takeaways showcased to me were that HIEs can help improve the coordination of patient care and improve public health outcomes. For example, when providers have access to the same patient data, they can better coordinate care and avoid duplicating tests and treatments. This can lead to better patient outcomes and lower costs. HIEs can also help to improve public health by being used to track the spread of diseases, identify outbreaks, and coordinate public health interventions. - Luke Keeler, Business Development and Outreach Specialist

“I learned a lot about future-thinking technologies that can be used to advance HIEs. For instance, the opt-out process for patients could be simplified with provider-facing consent applications. This would allow patients to capture their preferences electronically and store consent in a universally accessible manner.

Storing data with tags, such as sensitive information or diagnoses, can assist with filtering and help identify what data should be excluded from view.

User-based preferences for viewing data can help filter what providers see in the Clinical Portal. This can be especially useful to staff in the Emergency Department who need to see critical information and make life-saving decisions in a matter of minutes. Different information would have different value depending on the provider’s specialty, position, department.

Finally, I learned of the benefits of health data utilities being one system to go to for all health care data needs. NC HealthConnex already functions in this capacity. HDUs allow the use of claims and clinical data to pull more measures that will be useful to public health officials.” – Sasikala Nagarajan, HIE Integrations Specialist


NC HIEA Employees Help Food Bank

The NC HIEA Team holding signs for the Food Bank

Employees from the N.C. Department of Information Technology’s Data Division, including the NC HIEA, had a great time at a service event this month. Staff were busy packing 15,075 meals for the Food Bank of Central and Eastern NC. The boxes will be distributed to local food pantries in those regions.


Employee Spotlight

HIEA Employee

Fred Eaker

Implementation Program Manager

Fred joined the NC HIEA in May 2021 after more than a decade of supporting the health and wellness of students at NC State University.

As the implementation program manager for the NC HIEA, Fred is focused on maturing project management processes in collaboration with the state’s IT vendor. He closely tracks the status and critical tasks of vendor projects, curates project artifacts, and provides proactive, strategic input into operations and risk management.

Inspired by his graduate studies of Mahatma Gandhi, Fred strives to maintain a service-oriented approach to work and life. In his downtime, Fred enjoys gardening, landscaping, vegetarian cooking and taking long walks with his wife while their cats wait patiently for more attention.


Connex Kudos:

“Having our EHR seamlessly connected to NC HealthConnex has allowed our clinicians the ability to locate patient records more efficiently, therefore resulting in better care to improve the lives or our patients and their families.” - Amy Roberts, Director of Health Information Systems, Raleigh Neurology Associates, P.A.


Upcoming Events:

  • How to Connect Call – Monday, October 30, 2023 – 12 p.m. to 1 p.m. Register here.
  • Teletown Hall: Quarter 4 – Wednesday, November 15, 2023 – 12 p.m. to 1 p.m. Register here.
  • How to Connect Call – Monday, November 27, 2023 – 12 p.m. to 1 p.m. Register here.
  • Advisory Board Meeting – Thursday, December 7, 2023 – 2 p.m. to 5 p.m. Register here.


In The News:

In a Maternity Desert, a New Kind of Home Visitation Program Brings Care to At-Risk Mothers - Project Swaddle has expanded into a mobile integrated health care program offering wrap-around services to pregnant and postpartum women with a holistic approach.

User-Unfriendly EHRs Pose Serious Risks to Patient Safety - Electronic health records that deliver suboptimal user experience are more likely to lead to alert fatigue and less likely to catch errors that could impact hospital safety, University of Utah Health research shows.

There's a Direct Line Between Data Privacy and Patient SafetyHealth care organizations need to prepare for cyberattacks – and communicate honestly and promptly about security events with staff and patients when they occur, says Dr. Eric Liederman, director of medical informatics at Kaiser Permanente.

Cyber Attack: NC Hospitals Data Breach by Russian Cyber Gang – A Microsoft-owned health care technology firm revealed Friday that cyber thieves may have stolen personal data at major North Carolina hospitals as part of a massive international security breach this year.

Read more cybersecurity news and tips in the N.C. Department of Information Technology's Enterprise Security and Risk Management Office's August Cybersecurity newsletter.

Find more cybersecurity and risk management resources from the N.C. Department of Information Technology.